Licence Appeal Tribunal File Number: 24-002102/AABS
In the matter of an application pursuant to subsection 280(2) of the Insurance Act, RSO 1990, c I.8, in relation to statutory accident benefits.
Between:
Zi Ang Li
Applicant
and
Co-operators General Insurance Company
Respondent
DECISION
ADJUDICATOR:
Rasha El Sissi
APPEARANCES:
For the Applicant:
Ryan Olson, Paralegal
For the Respondent:
Stanislav Bodrov, Counsel
HEARD:
By way of written submissions
OVERVIEW
1Zi Ang Li, the applicant, was involved in an automobile accident on June 3, 2022, and sought benefits pursuant to the Statutory Accident Benefits Schedule –Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”). The applicant was denied benefits by the respondent, Co-operators General Insurance Company, and applied to the Licence Appeal Tribunal –Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
2The applicant was removed from the Minor Injury Guideline (“MIG”) due to a psychological impairment he incurred as a result of the accident.
ISSUES
3The issues in dispute are:
i. Is the applicant entitled to $1,518.69 for chiropractic services proposed by Easy Health Centre in a treatment plan / OCF-18 (“plan”) dated November 16, 2022?
ii. Is the applicant entitled to $1,496.00 for chiropractic services proposed by Easy Health Centre in a plan dated January 18, 2023?
iii. Is the applicant entitled to $448.92 ($2,804.12 less $2,355.20 approved) for psychological services proposed by Somatic Assessments & Treatment Clinic in a plan dated March 15, 2023?
iv. Is the applicant entitled to $590.76 ($2,056.08 less $1,465.32 approved) for psychological services proposed by Somatic Assessments & Treatment Clinic in a plan dated August 25, 2023?
v. Is the applicant entitled to $2,056.08 for psychological services proposed by Somatic Assessments & Treatment Clinic in a plan dated April 24, 2024?
vi. Is the respondent liable to pay an award under section 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
vii. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
4The applicant is not entitled to either of the plans for chiropractic services proposed by Easy Health Centre.
5The applicant is not entitled to the outstanding balances of the plans for psychological services dated March 15, 2023 and August 25, 2023.
6The applicant is entitled to $1,474.30, plus interest, for psychological services proposed by Somatic Assessments & Treatment Clinic in a plan dated April 24, 2024.
[7